MEDICARE: DR. IRINA GAAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A060033	CA

General Provider Information

NPI Number	:	1730309360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRINA GAAL M.D.

Provider Business Mailing Address
First Line	:	652 GOULD AVE
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2235
Country	:	US
Telephone Number	:	310-379-5949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E VICTORIA ST
Second Line	:	CSUDH - STUDENT HEALTH CENTER
City	:	CARSON
State	:	CA
Zip	:	90747-0001
Country	:	US
Telephone Number	:	310-243-3198
Fax Number	:	310-217-6990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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